PROMISING PRACTICES According to Calt.org5, the success of a DRS program can be measured by the percentage of diabetic patients who receive annual retinal examinations. Identifying diabetic patients without a retinal exam within one year of diagnosis will improve screening and treatment. The following recommendations improve compliance with annual retinal exams: • Identify and screen diabetic patients without requiring a referral from the primary care provider. Providers are often very busy and will neglect to initiate the referral for screening. Diabetic registries or electronic medical records are often effective in identifying patients who need DRS. • Screen all diabetic patients regardless of previous eye exams. Patients often report having had a regular eye exam, but a report of the findings is not available in the patient record. Patients are sometimes mistaken when they receive a simple eye examination for eyeglasses, thinking that a thorough view of the retina was performed. • Closely follow patients that fail the screening and are referred for retinal treatment. Diabetic retinopathy is often asymptomatic, even in the late stages, and patients will often neglect to obtain treatment. It is incumbent upon the primary care staff, as well as the retinal consultants, to ensure that the patient actually receives proper treatment. Sample protocols and consent forms can be found in Appendix A.
HOW TO ENSURE A SUCCESSFUL DRS PROGRAM: 1. Communicate your support for the program at its inception and on an ongoing basis – your buy-in is absolutely essential in motivating the clinic staff. Ask for updates at staff meetings, and promote the clinic’s goals, milestones and successes. 2. Take a team approach to integrating screening into clinic workflow, enlisting the support of case managers, providers, photographers, and support staff. This may require the flexibility to accept walk-in appointments for people who were not aware at the time of making their appointment that they should be having retinopathy exams. 3. Emphasize the critical role of primary care in overall management of diabetic eye health. Make sure that everyone at the clinic understands that screening is part of every diabetic’s care management program at the normal site of care, not something performed only by specialists. 4. Embrace telemedicine as a new model of care, communicate with IT professionals to ensure their support, and educate your clinic team about the key benefits of this approach, including speed of service, ease of process, lower costs, and better patient care. 5. Provide training, support, and recognition for staff to fit retinopathy screening into a comprehensive diabetes management plan. Make sure that participation in the program is reflected in performance measures.
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